Abstracts
1999 Digestive Disease Week

# 2086 PREDICTING THE NEED FOR COLECTOMY IN PEDIATRIC PATIENTS WITH ULCERATIVE COLITIS
R A Falcone, L G Lewis, B W Warner, Children's Hosp Med Ctr, Univ of Cincinnati, Cincinnati, OH

Ulcerative colitis in the pediatric population is a chronic disease that affects physical and emotional well being as well as growth. Although total colectomy is curative, it is difficult to predict which patients will require this intervention during childhood. The purpose of this review was to identify criteria associated with the need for colectomy thus avoiding prolonged medical management. Methods: A fifteen-year review of patients with biopsy proven ulcerative colitis managed medically and followed until age eighteen or the time of colectomy at a major pediatric referral center was performed. Age at the time of first symptom, diagnosis and surgery were recorded as well as steroid dependence (reliance on steroids for greater than three consecutive months), site of disease, extraintestinal manifestations and family history. Results: Seventy-three patients (range 1 - 18 years) were identified with a male to female ratio of 1:1. Thirty-seven patients (50.1%) required total colectomy prior to age 18 (Table; mean ± SEM). In steroid dependent patients with pancolitis, medical management failed in 77% (27/35) and colectomy was performed within three years of diagnosis. Conclusions: The combination of steroid-dependence and pancolitis was associated with a greater need for colectomy in children with ulcerative colitis. In pediatric patients with these factors, early colectomy may spare these patients the need to endure prolonged courses of medications and the allied disability with this disease.

	COLECTOMY	MEDICAL MANAGEMENT
Age at First Symptom	11.9±0.7 yrs	10.4±0.8 yrs
Age at Diagnosis	12.3±0.7 yrs	11.4±0.7 yrs
Age at Surgery	15.0±0.5 yrs	---
Steroid Dependence and Pancolitis	73%*	22%
Extraintestinal Manifestations	24%	16%
Family History	14%	11%

*P<0.05 by chi square

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